No. 28575 (Amendment): R414-1-5. State Plan

DAR File No.: 28575
Filed: 03/24/2006, 04:17
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

Subsection 26-18-3(2)(b) requires the Medicaid Program use rulemaking to implement policy. Therefore, the Utah Medicaid Program regularly goes through rulemaking to incorporate the most current Medicaid State Plan by reference.

 

Summary of the rule or change:

Subsection R414-1-5(2) is changed to update the incorporation of the State Plan by reference to September 1, 2005.

 

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

 

This rule or change incorporates by reference the following material:

Utah Medicaid State Plan, September 1, 2005

 

Anticipated cost or savings to:

the state budget:

There have been 18 State Plan Amendments approved since this rule was last amended. The following eight have no budget impact: 03-015-UT Mental Health Services by Community Mental Health Centers; 03-024-UT Targeted Case Management for the Chronically Mentally Ill Reimbursement Methodology; 04-008A-UT Long Term Acute Care Project; 04-008B-UT Long Term Acute Care Project; 04-008C-UT Long Term Acute Care Project; 04-015 Targeted Case Management for the Chronically Mentally Ill; 04-016 Limited Disenrollment; and 04-018 Personal Care Services in a Recipient's Home. 03-017 Aged and Disabled Spenddown Level had a federal cost of $2,300,000 and a state cost of $912,300 in FY 2004 and a federal cost of $2,300,000 with a state cost of $892,700 in FY 2005; 04-005 Nursing Facility Payments had a federal cost of $26,000,000 matched by $10,091,100 in the form of a nursing facility tax in FY 2005; 04-007-UT Dental Services had no impact in 2004 and a federal cost of $2,543,249 and a state cost of $1,033,251 for FY 2005; 04-009 Diabetes Self-Management Training cost $720 federal and $280 state money in FY 2004 and $2,773 federal and $72,167 state in FY 2005; 04-011-UT Home Health Services had a federal cost of $91,186 and a state cost of $35,670 in FY 2004, and a federal cost of $179,966 and a state cost of $69,844 in FY 2005; 04-012 Rural Hospital Augmented DSH had an annual federal cost of $1,563,050 and a state cost of $606,650 in FY 2005; 04-013 Physician Payment Enhancement had a federal cost of $10,694,850 matched by University of Utah seed money totaling $4,150,850 in FY 2005, and a federal cost of $10,694,850 matched by University of Utah seed money totaling $4,345,050 in FY 2006; 05-003 San Juan County Reimbursement Enhancement, has an estimated annual federal cost of $112,820 and an annual state cost of $44,980; 05-006-UT External Quality Review Organizations, has an estimated annual federal cost of $731,030 and an annual state cost of $290,670; 05-007 Dental Changes has an annual federal budget impact of $9,306,521 and an annual state impact of $3,780,979.

 

local governments:

04-005 Nursing Facility Payments through federal matching funds and nursing facility taxes saw local nursing facilities receive payments of approximately $36,091,100; and 04-012 Rural Hospital Augmented DSH provided payments to local government hospitals in the amount of $2,169,700 in FY 2005.

 

other persons:

04-005 Nursing Facility Payments required local government nursing facilities to pay a tax of $10,091,100 in FY 2005. All of that was returned plus federal matching funds totaling $36,091,100.

 

Compliance costs for affected persons:

Individual nursing facilities and their patients will likely not be affected by the local government nursing facility tax of $10,091,100 in FY 2005 (04-005 Nursing Facility Payments) since the federal match will more than offset the tax. The total coming to nursing facilities will be $36,091,100.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

This is necessary to keep Medicaid rules consistent with the federally approved State Plan. David N. Sundwall, MD, Executive Director

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

 

Direct questions regarding this rule to:

Ross Martin or Craig Devashrayee at the above address, by phone at 801-538-6592 or 801-538-6641, by FAX at 801-538-6099 or 801-538-6099, or by Internet E-mail at [e-mail] or [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2006

 

This rule may become effective on:

05/16/2006

 

Authorized by:

David N. Sundwall, Executive Director

 

 

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-1. Utah Medicaid Program.

R414-1-5. State Plan.

(1) As a condition for receipt of federal funds under title XIX of the Act, the Utah Department of Health must submit a State Plan contract to the federal government for the medical assistance program, and agree to administer the program in accordance with the provisions of the State Plan, the requirements of Titles XI and XIX of the Act, and all applicable federal regulations and other official issuances of the United States Department of Health and Human Services. A copy of the State Plan is available for public inspection at the Division's offices during regular business hours.

(2) The department adopts the Utah State Plan Under Title XIX of the Social Security Act Medical Assistance Program, in effect September 1, 200[4]5, which is incorporated by reference.

 

KEY: Medicaid

Date of Enactment or Last Substantive Change: [September 26, 2005]2006

Notice of Continuation: April 30, 2002

Authorizing, Implemented, or Interpreted Law: 26-1-5; 26-18-1